A peptic ulcer describes a pronounced defect of the gastrointestinal mucosa, usually of the stomach or duodenum.
The bacterium Helicobacter pylori appears to play a crucial role in the development of peptic ulcers.1 The prevalence of Helicobacter pylori infection varies widely both between industrialized and developing countries and within individual societies. The infection induces chronic active gastritis; a possible complication or secondary disease of this is, among others, gastroduodenal ulcer disease.2 The aim of therapy is the eradication of Helicobacter pylori via antibacterial substances and the neutralization or inhibition of acid secretion via antisecretory agents such as famotidine or sucralfate.
Other causes of peptic ulcers include disorders in the mucosal defense mechanism, reflux of intestinal contents into the stomach, or delayed gastric emptying, as well as emotional stress, smoking, alcohol, and the use of nonsteroidal anti-inflammatory drugs or corticosteroids.1
Numerous studies show that nonsteroidal anti-inflammatory drugs lead to gastroduodenal ulcers with increased incidence of bleeding in a dose-dependent manner. Risk factors for upper gastrointestinal bleeding, in addition to age (over 60 or 65 years), include male sex, previous gastrointestinal bleeding or history of gastroduodenal ulcers, oral anticoagulation, and use of corticosteroids. Prospective randomized, double-blind trials have demonstrated that the risk of such bleeding can be significantly reduced by taking proton pump inhibitors.2
1 Sweetman SC (ed.), Martindale. The Complete Drug Reference: http://www.medicinescomplete.com/ (accessed: 11/20/2013).
2 Fischbach et al: S3 guideline “Helicobacter pylori and gastroduodenal ulcer disease” of the German Society for Digestive and Metabolic Diseases (DGVS). Z Gastroenerol 2009, 47: 68-102.